Hürrem BODUR, Esragül AKINCI, Arzu YETKİN, Pınar ÖNGÜRÜ, Burcu ÖZDEMİR, Sevim YILMAZ, Ayşe BUT

Renal Sendrom ile Seyreden Kanamalı Ateş: İki Olgu Sunumu

Hantavirüsler Bunyaviridae ailesine ait olup insanlarda iki tip enfeksiyona neden olmaktadır: Renal sendrom ile seyreden kanamalı ateş (RSKA) ve hantavirüs kardiyopulmoner sendrom (HKPS). Ülkemizde ilk kez 2009 yılında görülen RSKA; akut başlangıçlı renal yetmezlik, hipotansiyon, kanama ve damar geçirgenliğindeki artma ile seyreden bir hastalıktır. Kliniğimize Kastamonu’nun kırsalından ateş, baş ve göz ağrısı, karın ağrısı, halsizlik ve iştahsızlık şikayeti ile başvuran iki hastada ateş, trombositopeni, kreatinin ve C-reaktif protein yüksekliği saptanmıştır. Hastaların ayırıcı tanısında geldikleri bölge nedeni ile Kırım-Kongo kanamalı ateşi, leptospirozis ve RSKA düşünülmüştür. Hastalarda serum anti-hantavirüs IgM indirekt immünfloresan testi (IFA) ve hantavirüs immunblot testi pozitif saptanmıştır. Takiplerinde genel durumları düzelen hastalar şifa ile taburcu edilmiştir.RSKA ülkemizde sıklıkla Karadeniz Bölgesinde görülmesine rağmen daha önce Kastamonu’dan bildirilen olgu mevcut değildir. Kırsal alandan gelen hastalarda ani gelişen ateş, trombositopeni ve akut böbrek yetmezliği durumlarında RSKA ayırıcı tanılar arasında yer almalıdır.

Hemorrhagic Fever With Renal Syndrome: Two Case Reports

Hantavirus, a member of the family Bunyaviridae, causes two types of infection in humans: hemorrhagic fever with renal syndrome (HFRS) and Hantavirus cardiopulmonary syndrome (HCPS). HFRS, first reported in Turkey in 2009, is related with renal insufficiency, hypotension, bleeding and increase in vascular permeability. Two patients were admitted from Kastamonu with fever, abdominal pain, headache, eye pain, weakness and decrease in appetite. Fever, thrombocytopenia, elevated creatinine and CRP were detected. Crimean-Congo hemorrhagic fever, leptospirosis and HFRS were considered in the differential diagnosis. In the sera of patients, anti-hantavirus IgM (detected with indirect immunofluorescent antibody (IFA) test) and hantavirus immunoblotting assay were positive. In their follow-up, patients recovered from their illness and were discharged. In Turkey, although cases of HFRS were usually reported in the Black Sea region, there was not any case reported from Kastamonu province. HFRS should be considered in the differential diagnosis of cases referred from rural parts of our country with presentation of rapid onset fever, thrombocytopenia and acute renal insufficiency.

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